Nutrition Management of Gestational Diabetes Mellitus

64 min read / 05.03.2021

Key Insight

Gestational diabetes mellitus (GDM) is one of the most common metabolic disturbances that occurs during pregnancy. A successful approach for addressing GDM is the use of medical nutrition therapy. The goal of medical nutrition therapy is to meet maternal and fetal nutritional needs while maintaining optimal glycemic control. This strategy is based
on providing individualized advice alongside practical tools and training to optimize nutrition self-management and healthy eating. Rather than focusing on dietary restriction, it is important to shift the emphasis towards the consumption of quality foods, such as fruits, vegetables, and complex carbohydrates high in fiber.

Current knowledge

The combination of high pre-pregnancy body mass index (BMI) and excessive weight gain during pregnancy increases the risk of complications including GDM, pre-eclampsia, and babies born large for gestational age. In spite of the well-established risks for mothers and babies, there is a lack of clear guidance on the best way to address GDM. The most widely used guideline for gestational weight gain is from the Institute of Medicine (IOM); however, the IOM does not provide specific recommendations for women with GDM. The conventional strategy for addressing GDM is based on a rigid limitation of all types of carbohydrates. Although this may help to
control glucose levels, this approach fosters maternal anxiety and is an important barrier to adherence. Considering the impact of GDM on future health of the mother and the offspring, preventive strategies could have several benefits. Practical implications

Practical implications

Besides conventional carbohydrate restriction, studies demonstrate that the type and quality of carbohydrate is an important consideration. In general, diets with a low to moderate glycemic index have been shown to have a positive effect on maternal outcomes with no adverse effects on the newborn. Intake of fiber (particularly soluble fiber) is beneficial for lowering serum lipids and reducing glycemic fluctuations. In addition, limiting total and saturated fats, while ensuring adequate levels of protein, are important for maintaining optimal fetal growth. There is evidence that regimens such as the Mediterranean and DASH diets may be beneficial within this context. For women at risk of developing GDM, nutritional strategies, such as probiotics and myo-inositol, might help reduce the risk of GDM when associated with a healthy lifestyle.

Key Messages

• Medical nutrition therapy is the bedrock for managing GDM.
• Many different approaches to nutrition therapy work and are equally effective. More than restriction, it is important to focus on quality of carbohydrates and encourage
consumption of vegetables, fruits, complex carbohydrates, and high-fibre foods.
• Monitoring gestational weight gain, self-monitoring of blood glucose and foetal growth is important to modify nutrition advice to achieve optimal outcome for the mother and the newborn.
• Key to success is to provide individualized advice supported by practical tools and training for nutrition self-management and healthy eating and regular follow-up with a dietician or other health care professional trained to provide nutrition counselling.

Keywords

Gestational diabetes · Management · Nutrition

Abstract

Medical nutrition therapy (MNT) is the bedrock for the management of gestational diabetes mellitus (GDM). Several different types of dietary approaches are used globally, and there is no consensus among the various professional groups as to what constitutes an ideal approach. The conventional approach of limiting carbohydrates at the cost of increasing energy from the fat source may not be most optimal. Instead,
allowing higher levels of complex, low-to-medium glycaemic index carbohydrates and adequate fibre through higher consumption of vegetables and fruits seems more beneficial. No particular diet or dietary protocol is superior to another as shown in several comparative studies. However, in each of these studies, one thing was common – the intervention arm included more intensive diet counselling and more frequent visits to the dieticians. For MNT to work, it is imperative that diet advice and nutrition counselling is provided by a dietician, which is easy to understand and use and includes healthy food options, cooking methods, and practical guidance that empower and motivate to make changes towards a healthy eating pattern. Various simple tools to achieve these objectives are available, and in the absence of qualified dieticians, they can be used to train other health care professionals to provide nutrition counselling to women with GDM. Given the impact of GDM on the future health of the mother and offspring, dietary and lifestyle behaviour changes during pregnancy in women with GDM are not only relevant for immediate pregnancy outcomes, but continued adherence is also important for future health.